Upright or Lying Down?

Most people assume lying on a bed to labour and birth a baby is best because that’s what they see in movies. A new study published this month shows that this is many women’s lived experience. But, the reality is lying on your back to birth your baby works against you and being mobile and upright helps labour progress and makes birth easier.

Why are women giving birth on their backs?

What happens in Belgium?

Do you have to get on the bed?

Support in Labour

Being mobile in labour doesn’t mean you have to stand up all the time!

A new study published this month (Kjeldsen et al 2025) concluded that most women spend 80% of the day before birth in positions that limit sacrum movement, and over 90% give birth this way i.e. on their backs on a bed. Yet we know:

“The physiological advantages of upright positions include the positive influence of gravity, stronger and more efficient uterine contractions, improved alignment of the foetus for passage through the pelvis and improved acid–base outcomes in the newborn.”

“These advantages are supported by evidence from randomized controlled trials of varying quality. The studies focus on the second stage of labour, describing shorter duration of the second stage of labour, lower risk of episiotomy, lower risk of assisted vaginal birth, no difference in the risk of perineal tears but a higher risk of blood loss during childbirth.” Kjeldsen et al 2025

and the Cochrane Review on maternal positions and mobility during first stage labour found that:

“There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers’ and babies’ well being. Given the great heterogeneity and high performance bias of study situations, better quality trials are still required to confirm with any confidence the true risks and benefits of upright and mobile positions compared with recumbent positions for all women. Based on the current findings, we recommend that women in low-risk labour should be informed of the benefits of upright positions, and encouraged and assisted to assume whatever positions they choose.” (Lawrence et al 2013).

Looking at the the Belgian Guideline on Low-Risk Birth (KCE Reports 139C, 2010) it is clear they embrace the importance of letting women choose positions that support labour progress, comfort, and effective pushing. But, whether the practice cascades down to a woman in labour in hospital is difficult to know. Induction of labour, medical interventions, foetal monitoring and an epidural can all limit your mobility and there is a high chance they will be offered to you. For context the epidural rate in Belgium is around 77% and in some hospitals as high as 90% for first time mums. Plus, seeing a bed as the most prominent feature of the birthing room reinforces the idea that a bed is the most important piece of furniture, and that you are expected to get on it. This isn’t ideal because lying in bed does the opposite of helping labour progress and providing the benefits mentioned above. So,

What Can You Do?

If you're about to give birth, the answer is simple:

• You don’t have to get on the bed if you don’t want to

• If you're asked to, ask why before deciding

• If you do get on the bed for a test or exam, you can get off afterwards

• You don’t need permission to move your own body. Say no if something doesn’t feel right

• Take time to understand about the physiology of labour and birth, the maternity system in Belgium and about interventions such as induction, epidurals, and foetal monitoring. Understanding your choices gives you the confidence to make informed decisions, have agency over your birth experience and ensure you have the best birth experience for you and your baby

  AND ABOVE ALL

  Choose carefully where you birth your baby and who cares for you!

On all fours - a labouring woman

Trust Your Body

Know Your Options

Own Your Birth

Written by Kate Ellwood, Childbirth Educator and Hypnobirthing Teacher

With thanks to Dr Sara Wickham and her relentless desire to inform and share research on pregnancy, labour and birth to all!

www.sarawickham.com/original-articles/upright-positions/ Accessed: 02 2025